PURPOSE: Racial disparities in treating pain with opioids are widely reported; however, differences in use of recommended strategies to reduce the risk of opioid misuse by race/ethnicity have not been evaluated. METHODS: In a retrospective cohort of black and white patients with chronic noncancer pain prescribed opioid analgesics for at least 3 months, we assessed physicians' use of 3 opioid risk reduction strategies: (1) urine drug testing, (2) regular office visits (at least 1 visit per 6 months on opioids and within 30 days of an opioid change), and (3) restricted early opioid refills (receipt of a refill >1 week early less than twice). Nonlinear mixed effect regression models accounted for clustering within physician and adjusted additively for demographics, substance abuse, mental health and medical comorbidities, health care factors, and practice site. RESULTS: Of the 1,612 patients studied, 62.1% were black. Black patients were more likely than white patients to receive urine drug testing (10.4% vs 4.1%), regular office visits (56.4% vs 39.0%), and restricted early refills (79.4% vs 72.0%) (P <.001 for each). In fully adjusted models, black patients had significantly higher odds than their white counterparts of receiving regular office visits (odds ratio = 1.51; 95% confidence interval, 1.06-2.14) and restricted early refills (odds ratio = 1.55; 95% confidence interval, 1.03-2.32), but not urine drug testing (odds ratio = 1.41; 95% confidence interval, 0.78-2.54). CONCLUSIONS: In this cohort of primary care patients receiving opioid analgesics on a long-term basis, use of risk reduction strategies was very limited overall; however, black patients were more likely than white patients to receive 2 of 3 guideline-recommended strategies. These data raise questions about lax monitoring, especially for white patients taking opioids long term.
PURPOSE: Racial disparities in treating pain with opioids are widely reported; however, differences in use of recommended strategies to reduce the risk of opioid misuse by race/ethnicity have not been evaluated. METHODS: In a retrospective cohort of black and white patients with chronic noncancer pain prescribed opioid analgesics for at least 3 months, we assessed physicians' use of 3 opioid risk reduction strategies: (1) urine drug testing, (2) regular office visits (at least 1 visit per 6 months on opioids and within 30 days of an opioid change), and (3) restricted early opioid refills (receipt of a refill >1 week early less than twice). Nonlinear mixed effect regression models accounted for clustering within physician and adjusted additively for demographics, substance abuse, mental health and medical comorbidities, health care factors, and practice site. RESULTS: Of the 1,612 patients studied, 62.1% were black. Black patients were more likely than white patients to receive urine drug testing (10.4% vs 4.1%), regular office visits (56.4% vs 39.0%), and restricted early refills (79.4% vs 72.0%) (P <.001 for each). In fully adjusted models, black patients had significantly higher odds than their white counterparts of receiving regular office visits (odds ratio = 1.51; 95% confidence interval, 1.06-2.14) and restricted early refills (odds ratio = 1.55; 95% confidence interval, 1.03-2.32), but not urine drug testing (odds ratio = 1.41; 95% confidence interval, 0.78-2.54). CONCLUSIONS: In this cohort of primary care patients receiving opioid analgesics on a long-term basis, use of risk reduction strategies was very limited overall; however, black patients were more likely than white patients to receive 2 of 3 guideline-recommended strategies. These data raise questions about lax monitoring, especially for white patients taking opioids long term.
Authors: Joanna L Starrels; William C Becker; Daniel P Alford; Alok Kapoor; Arthur Robinson Williams; Barbara J Turner Journal: Ann Intern Med Date: 2010-06-01 Impact factor: 25.391
Authors: Carmen R Green; Karen O Anderson; Tamara A Baker; Lisa C Campbell; Sheila Decker; Roger B Fillingim; Donna A Kalauokalani; Donna A Kaloukalani; Kathyrn E Lasch; Cynthia Myers; Raymond C Tait; Knox H Todd; April H Vallerand Journal: Pain Med Date: 2003-09 Impact factor: 3.750
Authors: Jane M Liebschutz; Ziming Xuan; Christopher W Shanahan; Marc LaRochelle; Julia Keosaian; Donna Beers; George Guara; Kristen O'Connor; Daniel P Alford; Victoria Parker; Roger D Weiss; Jeffrey H Samet; Julie Crosson; Phoebe A Cushman; Karen E Lasser Journal: JAMA Intern Med Date: 2017-09-01 Impact factor: 21.873
Authors: Joanna L Starrels; Bryan Wu; Deena Peyser; Aaron D Fox; Abigail Batchelder; Frances K Barg; Julia H Arnsten; Chinazo O Cunningham Journal: J Opioid Manag Date: 2014 Mar-Apr